A cluster analysis-derived classification of psychological distress and illness behavior in the medically ill

• Published in: Psychological medicine Vol. 42; no. 2; pp. 401 - 407
• Main Authors: Fava, G. A., Guidi, J., Porcelli, P., Rafanelli, C., Bellomo, A., Grandi, S., Grassi, L., Mangelli, L., Pasquini, P., Picardi, A., Quartesan, R., Rigatelli, M., Sonino, N.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.02.2012
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Chronic Disease - psychology; Classification; Cluster Analysis; Consultation; Depression; Eligibility; Feasibility Studies; Female; Health behaviour; Humans; Illness Behavior - classification; Irritable Mood - classification; Male; Medical sciences; Mental disorders; Middle Aged; Miscellaneous; Mood disorders; Mood Disorders - classification; Psychiatric Status Rating Scales; Psychological distress; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Somatization; Somatoform Disorders - classification; Somatoform Disorders - diagnosis; Somatoform disorders. Psychosomatics; Stress, Psychological - classification; Stress, Psychological - diagnosis; Syndrome; Type A Personality; illness behaviour; Anxiety; depression; diagnostic criteria for psychosomatic research; cluster analysis; Mood disorder; Affect affectivity; Automatic classification; Depression; Distress behavior; Psychosomatics; Criterion; Psychological distress; Somatoform disorder; Health behavior; Diagnosis; Somatic disease
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291711001231

The classification of psychological distress and illness behavior in the setting of medical disease is still controversial. Current psychiatric nosology does not seem to cover the spectrum of disturbances. The aim of this investigation was to assess whether the joint use of DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR), that provide identification of syndromes related to somatization, abnormal illness behavior, irritable mood, type A behavior, demoralization and alexithymia, could yield subtyping of psychosocial variables in the medically ill. A cross-sectional assessment using both DSM-IV and the DCPR was conducted in eight medical centers in the Italian Health System. Data were submitted to cluster analysis. Participants were consecutive medical out-patients and in-patients for whom a psychiatric consultation was requested. A total of 1700 subjects met eligibility criteria and 1560 agreed to participate. Three clusters were identified: non-specific psychological distress, irritability and affective disturbances with somatization. Two-step cluster analysis revealed clusters that were found to occur across clinical settings. The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, illness behavior and subclinical distress encompassed by the DCPR.